RESEARCH PAPER
Tobacco craving and withdrawal symptoms in psychiatric patients during a motivational enhancement intervention based on a 26-hour smoking abstinence period
 
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1
Department of Mental Health and Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
2
Faculty of Medicine, University of Geneva, Geneva, Switzerland
3
Carrefour Addictions, CIPRET, Geneva, Switzerland
CORRESPONDING AUTHOR
Ineke Keizer   

Department of Mental Health and Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
Publish date: 2019-06-17
Submission date: 2018-12-20
Final revision date: 2019-05-31
Acceptance date: 2019-06-02
 
Tob. Prev. Cessation 2019;5(June):22
KEYWORDS
TOPICS
ABSTRACT
Introduction:
In psychiatric patients, tobacco withdrawal symptoms are frequently seen as a barrier to smoking cessation; however, further studies are warranted in this specific population.

Methods:
Patients receiving in- or out-patient mental health care participated in a motivational enhancement program including a 26-hour tobacco abstinence experience with professional support and optional nicotine replacement therapy. The study included 174 subjects, of whom 159 were evaluated 1 week before and at the end of the 26-hour abstinence period. Repeated assessments included the Minnesota Nicotine Tobacco Withdrawal Scale Revised (MNWS-R), two items of the Mood and Physical Symptoms Scale (MPSS) regarding craving, the State-Trait Anxiety Inventory (STAI-S), the Beck Depression Inventory (BDI-21), and the World Health Organization Well-Being Index (WHO-5).

Results:
More than half the participants (52.3%) succeeded in 26-hour smoking abstinence. Craving was the most frequent MNWS-R withdrawal symptom (28.3% scored ≥3 on a 0–4 scale). Comparison of pre- and post-intervention data revealed significant improvements in 13 of 16 MNWS-R symptoms as well as craving (MPSS) and well-being, and significant decreases in anxiety and depression. Increasing MNWS-R craving scores and greater depression were both significantly associated with lower success in the 26-hour smoking abstinence period.

Conclusions:
The negative effects of tobacco withdrawal symptoms in psychiatric patients may be substantially overestimated. Participation in a supportive structured motivational intervention with a 26-hour smoking cessation experience was well tolerated and contributed to temporary improvements in mental state. Craving is an interesting symptom to evaluate during smoking cessation attempts.

ACKNOWLEDGEMENTS
We thank the following heads of services for their collaboration in the intervention: Jean-Pierre Bachetta, Javier Bartolomei, Logos Curtis, Philippe Huguelet, Othman Sentissi, and the heads of the Department of Mental Health and Psychiatry, Panteleimon Giannacopoulos and Jean-Michel Aubry for support. We thank the tobacco specialists for their interventions in the program, in particular Corinne Wahl (Carrefour addictions/ CIPRET-Geneva), who participated in all the outpatient ‘Day off’ sessions and provided detailed tobacco information, and Patricia Borrero (Directorate of Nursing Services, University Hospitals of Geneva), who provided interactive tobaccoinformation sessions for the inpatient groups.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
This study received no specific funding; the authors were employed by the University Hospitals of Geneva and/or the University of Geneva. Small funds to implement the outpatient portion of the ‘Day off’ intervention were provided by Carrefour addictions/CIPRET-Genève, Centre d’Information et de Prévention du Tabagisme. All participating institutions are funded by the state of Geneva, and the study involved no private funds.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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